prp biologics 2
TRANSCRIPT
How is PRP Used?
Office Setting- 50 minute procedure
Phlebotomist
Centrifuge
Injection
Sonosite MSK Ultrasound
Surgical Adjunct- adds some time
PRFM-platelet rich fibrin matrix
Activated PRP-gel form
Unactivated PRP-Liquid Form
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How is PRP Processed?
-Draw 20-60-120 cc’s venous blood
-Blood is placed into a centrifuge
-Separates RBC’s from plasma and WBC’s and platelets
-Platelets and some WBC’s suspended in plasma
-Forms a concentrate of platelets in a small amount of plasma for injection
-PRP is then injected into affected site.
-Usually 2-3 injections may be required.
-Patients begin to respond within the first week.
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PRP Blood Draw
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Steps-Blood Prep
1 2
3 4
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Steps-Centrifuge
5
6
7
8 8
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Preparing PRP Video Bennett Orthopedics and Sportsmedicine
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Arthrex ACP
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What can be Treated with
PRP? Tendon Injuries
Tennis Elbow Golfer’s Elbow Jumper’s Knee Plantar Fasciitis
Rotator Cuff Tears
Ligament Injuries Medial Collateral Ligament
Anterior Cruciate Ligament Tears
Cartilage Injuries Chondromalacia Meniscal Injuries
Osteoarthritis
Bone Non-Unions
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PRP Studies-as of 2011
International Cartilage Repair Society, 10th World Congress, Montreal 2012 copyright 2012
Office Examples
Injection
Ultrasound Guided
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PRP-Tennis Elbow Injection
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PRP-Knee-Injection
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SONOSITE
MSK
Ultrasound
Military Development
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Ultrasound Posterior Labrum
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Ultrasound Elbow
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PRP-Tennis Elbow
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Ultrasound Proximal Biceps
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Ultrasound Distal Biceps
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Ultrasound/PRP Distal Biceps
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Ultrasound-PRP-Gluteus
Medius
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Injections/Response Time
From 1-3, depending on Condition
Local Anesthetic, for tendon injuries
Time to response varies, 2 days to 3 months
Can worsen symptoms up to 2 weeks
May not need to cease activity
Duration-data is evolving
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PRE-POST Knee X-rays
64 year Old Female Tennis
player 6 months post-PRP injection x 3
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Close-Up-Right
8/2010-Pre-Right 2/2011-Post-Right
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Close-Up Left
8/2010-pre-left
2/2011-post-Left
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My Experience
> 6 years
90 percent+ responders- all conditions
7 percent overall failure rate-all conditions
70 percent improvement with one injection in Osteoarthritis or Chondromalcia
90 percent plus with 2nd and 3rd injection in Osteoarthritis and Chondromalcia
5 percent repeat injections, only Osteoarthritis or Chondromalcia
Degradation of response in Osteoarthritis and Chondromalcia does not go to zero
Duration-Osteoarthritis and Chondromalcia-85 percent 18 months or more
Tendon/Labrum/Meniscus- 70-80 percent responders-takes longer~ 3 -4 months
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OsteoArthritis
Studies- PRP
International Cartilage Repair Society, 10th World Congress, Montreal 2012
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PRP and Osteoarthritis
International Cartilage Repair Society, 10th World Congress, Montreal 2012
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Osteoarthritis
Positive PRP
Fortier, 2011 International Cartilage Repair Society, 10th World Congress, Montreal 2012
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PRP Duration
Kohn, Italy, 2011 International Cartilage Repair Society, 10th World Congress, Montreal 2012
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PRP-Duration-Cartilage
Damage/Early and Advanced
Osteoarthritis
Kohn , Italy 2011 International Cartilage Repair Society, 10th World Congress, Montreal 2012
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PRP and Hyaluronic Acid
Lubricating Injections
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A Randomized Clinical Trial Evaluating Plasma Rich in growth Factors(PRGF-Endoret) Versus
Hyaluronic Acid in the Short-Term treatment of Symptomatic Knee Osteoarthritis
Sanchez M, Arthroscopy, August Vol.28, No. 8 2012
Hyaluronic Acid Reduction in pain.
PRGF- High percent reduction in pain
PRGF lasting out to 24 weeks
Hype?Orthokine-Germany-ACS
Kobe/ARod/Couples
International Cartilage Repair Society, 10th World Congress, Montreal 2012
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Kobe/A-Rod/Couples
ACS-ORTHOKINE
International Cartilage Repair Society, 10th World Congress, Montreal 2012
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PRP-Summary
Fairy Tale or Fairly Useful?
Anti-Inflammatory-although early can be increased
Catabolic to Anabolic
Synovial Cells Secrete Hyaluronic Acid
Target Cells All Respond
Recruit Stem Cells
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Fairly Useful?
No. Very useful!!!!
Can help to avoid surgery
Requires the proper use of PRP
Which requires variations in concentrations or substances for various injuries
May require various compositions in a temporal fashion as well
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